Provider Demographics
NPI:1710443262
Name:FERONS, CARA ANN WILCK
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ANN WILCK
Last Name:FERONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:A
Other - Last Name:WILCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5710 OLEANDER DR STE 211
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4722
Mailing Address - Country:US
Mailing Address - Phone:910-398-6301
Mailing Address - Fax:910-398-6305
Practice Address - Street 1:5710 OLEANDER DR STE 211
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4722
Practice Address - Country:US
Practice Address - Phone:910-398-6301
Practice Address - Fax:910-398-6305
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist